Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

Abstract

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

Predictors of Poor Outcome Despite Successful Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusions Within 6 h of Symptom Onset

“…Our study demonstrated that baseline NIHSS score, ICA occlusion, and DCM are independent predictors of poor functional outcome despite successful recanalization after MT within 6 h of symptom onset. Our finding of higher NIHSS score and its association with the poor functional outcome is consistent with several previous studies which evaluated the prognostic factors of outcome after MT ( 7 – 9 ). A high NIHSS on admission was also associated with both proximal ICA occlusion and poor collateral circulation ( 10 ).…”

Selective Brain Hypothermia in Acute Ischemic Stroke: Reperfusion Without Reperfusion Injury

“…Given the growing and widespread utilization of endovascular clot-extraction in LVO stroke and lack of additional means to counter the deleterious mechanisms of ischemia and reperfusion injury (12,85), SEBC is an appealing concept to reap the benefits of therapeutic hypothermia while minimizing the adverse effects of systemic hypothermia. Based on our current understanding of the mechanisms of stroke, reperfusion, and therapeutic (brain) hypothermia, it is reasonable to consider an improvement in outcome and reduction in the occurrence of post-stroke ICH may occur.…”

Impact of leukoaraiosis severity on the association of outcomes of mechanical thrombectomy for acute ischemic stroke: a systematic review and a meta-analysis

“…However, the reported rate of good post-MT functional outcome (modified Rankin Scale [mRS] score of 0-2 at 90 days) was < 50% [1]. Reported futile recanalization causes include old age, moderate and severe stroke, surgical-and instrument-related complications, delayed opening of blood vessels, distal vascular embolisms, and reocclusion [9][10][11]. Therefore, it is important to recognize poor outcome factors and select the most suitable patients for MT to improve the proportion of good outcomes.…”